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847: Quintero stage based outcomes in TTTS pregnancies undergoing selective laser photocoagulation
Poster Session V the weighted mean difference (WMD) and the standardized mean difference (SMD). For insulin use, the pooled odds ratio was estimated. Heterogeneity was tested by the Q statistic. RESULTS: Thirteen studies were identified. Maternal age and neonatal birthweight were found to be significant risk factors, but their estimated pooled effects were small (SMD¼0.29 [95%CI: 0.17-0.42] and SMD¼0.3 [95%CI: 0.10-0.51] respectively). For oral glucose tolerance test (OGTT), the fasting result had the largest difference (SMD¼0.42, [95%CI: 0.3-0.53]). Insulin use, BMI, and weight gain between pregnancies were significant with large effects (OR¼6.3 [95%CI: 3.9-10.2], SMD¼0.39 [95%CI: 0.25-0.53] and SMD ¼ 0.78 [95% CI: 0.15-1.42], respectively). Inter pregnancy interval (IPI) was not a significant risk factor (P¼0.97) possibly due to significant opposite findings of studies, depending on the cohort parity. CONCLUSION: Insulin use, OGTT levels, BMI, and weight gain between the pregnancies are the main risk factors for GDM recurrence. The non-significant result for IPI may be due to modification by parity and should be addressed in further studies.
CI¼confidence interval. BMI ¼ body mass index. OGTT ¼ oral glucose tolerance test. IPI ¼ interpregnancy interval. * Heterogeneity of the studies was explored using Cochrane’s Q test of heterogeneity (P<0.05 considered statistically significant). Random and fixed effects (DerSimonian and Laird and inverse variance methods, respectively) were chosen accordingly.
ajog.org 847 Quintero stage based outcomes in TTTS pregnancies undergoing selective laser photocoagulation
Nahla Khalek1, Anjani Villa1, Sarah Huepenbecker1, Shanaye Jeffers1, Chloe Getrajdman1, Julie Moldenhauer1, Juan Martinez-Poyer1, Mark Johnson1
1 The Children’s Hospital of Philadelphia, Center for Fetal Diagnosis and Treatment, Philadelphia, PA
OBJECTIVE: To report rates of live births and neonatal demise (NND) in monochorionic diamniotic (MCDA) twin pregnancies complicated by twin to twin transfusion syndrome (TTTS) which undergo selective laser photocoagulation (SLPC) in a single center based on each Quintero stage. STUDY DESIGN: Retrospective cohort review of live births and NND in pregnancies complicated by TTTS that underwent SLPC enrolled in a single center between January 2010 to June 2014. RESULTS: 177 SLPC procedures were performed during the study period. 15 pregnancies were excluded for various reasons (7 lost to follow up, 6 ongoing pregnancies, 2 remain hospitalized). 162 pregnancies were available for analysis. The number of TTTS pregnancies that underwent SLPC was as follows: Stage I (3), Stage II (89), Stage III (55), and Stage IV (15). Mean gestational age (GA) at time of SLPC did not significantly differ by Quintero stage. Mean GA at delivery for Stage I was 32.92 weeks (29.6-35.86), Stage II was 33.24 weeks (20.4-40.0), Stage III was 31.19 weeks (18.2-40.0) and Stage IV was 32.29 weeks (21.4-38.4). CONCLUSION: Independent of Quintero stage the mean GA at delivery is 32 weeks. The probability of dual survivors if both are born alive across all stages at the time of discharge is 93%. Stratified by Quintero stage, the probability of dual survivors if both are born alive at the time of discharge is 96% for Stage II, 83% for Stage III and 73% for Stage IV. There was no difference in single survivors born alive and remaining alive at the time of discharge based on Quintero stage.
NND by Quintero Stage. Live births by Quintero Stage.
848 Does vaginal bleeding in pregnancies with preterm premature rupture of membranes confer harm to the fetus?
Nana-Ama Ankumah1, Hector Mendez-Figueroa1, Robyn Roberts1, Sean Blackwell1, Baha Sibai1, Suneet Chauhan1 1 UT Health- University of Texas Medical School at Houston, OB/GYN, Houston, TX
Figure: meta-analysis for the association between insulin use and gestational diabetes mellitus recurrence.
OBJECTIVE: Vaginal bleeding occurs in 9% of pregnancies with preterm premature rupture of membranes (PPROM), but there is a paucity of data regarding neonatal morbidity in PPROM with VB.
S406 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
CI¼confidence interval. BMI ¼ body mass index. OGTT ¼ oral glucose tolerance test. IPI ¼ interpregnancy interval. * Heterogeneity of the studies was explored using Cochrane’s Q test of heterogeneity (P<0.05 considered statistically significant). Random and fixed effects (DerSimonian and Laird and inverse variance methods, respectively) were chosen accordingly.
ajog.org 847 Quintero stage based outcomes in TTTS pregnancies undergoing selective laser photocoagulation
Nahla Khalek1, Anjani Villa1, Sarah Huepenbecker1, Shanaye Jeffers1, Chloe Getrajdman1, Julie Moldenhauer1, Juan Martinez-Poyer1, Mark Johnson1
1 The Children’s Hospital of Philadelphia, Center for Fetal Diagnosis and Treatment, Philadelphia, PA
OBJECTIVE: To report rates of live births and neonatal demise (NND) in monochorionic diamniotic (MCDA) twin pregnancies complicated by twin to twin transfusion syndrome (TTTS) which undergo selective laser photocoagulation (SLPC) in a single center based on each Quintero stage. STUDY DESIGN: Retrospective cohort review of live births and NND in pregnancies complicated by TTTS that underwent SLPC enrolled in a single center between January 2010 to June 2014. RESULTS: 177 SLPC procedures were performed during the study period. 15 pregnancies were excluded for various reasons (7 lost to follow up, 6 ongoing pregnancies, 2 remain hospitalized). 162 pregnancies were available for analysis. The number of TTTS pregnancies that underwent SLPC was as follows: Stage I (3), Stage II (89), Stage III (55), and Stage IV (15). Mean gestational age (GA) at time of SLPC did not significantly differ by Quintero stage. Mean GA at delivery for Stage I was 32.92 weeks (29.6-35.86), Stage II was 33.24 weeks (20.4-40.0), Stage III was 31.19 weeks (18.2-40.0) and Stage IV was 32.29 weeks (21.4-38.4). CONCLUSION: Independent of Quintero stage the mean GA at delivery is 32 weeks. The probability of dual survivors if both are born alive across all stages at the time of discharge is 93%. Stratified by Quintero stage, the probability of dual survivors if both are born alive at the time of discharge is 96% for Stage II, 83% for Stage III and 73% for Stage IV. There was no difference in single survivors born alive and remaining alive at the time of discharge based on Quintero stage.
NND by Quintero Stage. Live births by Quintero Stage.
848 Does vaginal bleeding in pregnancies with preterm premature rupture of membranes confer harm to the fetus?
Nana-Ama Ankumah1, Hector Mendez-Figueroa1, Robyn Roberts1, Sean Blackwell1, Baha Sibai1, Suneet Chauhan1 1 UT Health- University of Texas Medical School at Houston, OB/GYN, Houston, TX
Figure: meta-analysis for the association between insulin use and gestational diabetes mellitus recurrence.
OBJECTIVE: Vaginal bleeding occurs in 9% of pregnancies with preterm premature rupture of membranes (PPROM), but there is a paucity of data regarding neonatal morbidity in PPROM with VB.
S406 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015